What is the role of everolimus (Afinitor) in the treatment of renal cell carcinoma (RCC)?

Everolimus (Afinitor) is a serine-threonine kinase inhibitor of mTOR. This agent was approved by the FDA in 2009 for use in advanced renal cell carcinoma after failure of treatment with sunitinib or sorafenib.

The recommended everolimus dose for treatment of advanced renal cell carcinoma is 10 mg, to be taken once daily at the same time every day, with or without food.
[46] However, the tablets should be swallowed whole, not be chewed or crushed, with a glass of water.

Gross image of a bivalved kidney showing renal cell carcinoma in the upper half. The periphery of the carcinoma is yellow (due to high lipid content) with a central gelatinous area of necrosis.

H and E, high power of a clear cell renal cell carcinoma. The tumor cells have abundant pale "clear" cytoplasm.

H and E, low power of a papillary renal cell carcinoma. There are "finger-like" projections of fibrovascular stroma lined by malignant tumor cells that lack the abundant clear cytoplasm seen in a clear cell carcinoma.

H and E, high power of a chromophobe RCC composed of cells with clear, reticular cytoplasm and some with eosinophilic cytoplasm. The cell borders are often more distinct in this carcinoma than others and the nuclei are often smaller and darker.

H and E, high power of a collecting duct carcinoma composed of tubules lined by malignant cells in a background stroma that is fibrotic.

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